scholarly journals ANALYSIS OF THE PLATELET HEMOSTASIS AMONG PREGNANT WOMEN WITH IMMUNE THROMBOCYTOPENIA

2021 ◽  
pp. 61-75
Author(s):  
Yu.V. Davidova ◽  
V.Z. Netyazhenko ◽  
A.N. Naumchik ◽  
N.I. Kozachishin ◽  
A. Yu. Limanskaya
Keyword(s):  
Platelet Aggregation ◽  
Pregnant Women ◽  
Immune Thrombocytopenia ◽  
Obstetric Care ◽  
Severe Thrombocytopenia ◽  
Direct Function ◽  
Functional Potential ◽  
Gestational Thrombocytopenia ◽  
Gynecological Care ◽  
Frequent Reason

Relevance: Thrombocytopenia is a common hematological problem that accompanies pregnancy. From 5% to 12% of pregnancies are complicated by thrombocytopenia. Gestational thrombocytopenia is the leading cause of complications (70-85%). Immune thrombocytopenia (ITP) is the most frequent reason among pre-pregnancy causes of thrombocytopenia and is responsible for 1-4% of all thrombocytopenia cases during pregnancy. Investigation of the functional potential of the thrombocyte link of hemostasis in conditions of a reduced number of thrombocytes is relevant. The purpose of the study was to analyze the platelet link of hemostasis in pregnant women with ITP of varying severity by the method of light aggregometry. Materials and Methods: Eighty-eight women with gestational and 28 with immune thrombocytopenia were undergoing treatment and delivery at the Institute of Pediatrics, Obstetrics and Gynecology of NAMS of Ukraine (Kyiv, Ukraine) from September 2018 to February 2021. The platelet link of hemostasis was studied in a group of women with immune thrombocytopenia; six (21.4%) of them had severe thrombocytopenia. Results: In mild and moderate immune thrombocytopenia, we noted a decrease in spontaneous and induced platelet aggregation; in severe immune thrombocytopenia, there was no spontaneous and a decreased induced platelet aggregation. This indicated a reduced potential of platelets to perform their direct function – the formation of a thrombus. Conclusion: Immune thrombocytopenia accounts for most pre-pregnancy conditions causing thrombocytopenia in pregnant women. Light aggregometry is a relevant and indicative way to analyze the aggregative ability of platelets. A multidisciplinary team consisting of an obstetrician-gynecologist, hematologist, anesthesiologist, and neonatologist should be involved in the management of such cases to provide effective obstetric care for this category of pregnant women. Risks for the mother and the fetus/newborn should be assessed throughout the pregnancy, considering clinical and laboratory aspects. Delivery of pregnant women with severe thrombocytopenia should be managed at institutions providing the highest level of obstetric and gynecological care.

scholarly journals Low platelet counts in pregnancy: an alarm signal for abruption!

2018 ◽  
Vol 7 (3) ◽  
pp. 1191 ◽  
Author(s):  
Anjali Mundkur ◽  
K. P. Murali Krishnan Nambiar ◽  
Lavanya Rai
Keyword(s):  
Platelet Count ◽  
Pregnant Women ◽  
Connective Tissue Disorder ◽  
Severe Thrombocytopenia ◽  
Related Condition ◽  
Alarm Signal ◽  
Hematologic Disorder ◽  
Gestational Thrombocytopenia ◽  
In Pregnancy ◽  
Do So

Background: Thrombocytopenia, defined as a platelet count less than 150 million/mm3, affects 6% to 10% of all pregnant women and other than anemia is the most common hematologic disorder in pregnancy.Methods: We studied all patients with thrombocytopenia in pregnancy from June 2012 to May 2013. There were 86 patients recruited into the study. Pregnant women with preeclampsia and suspected connective tissue disorder were also screened for thrombocytopenia. All women with platelet count of <1.50,000/µl during the study period were included.Results: Patients were grouped in to mild thrombocytopenia (platelet 100,000-149,999/µl), moderate thrombocytopenia (platelet 50,000-99,999/µl) and severe thrombocytopenia (platelet <49,999/µl. Pregnancy specific cause of thrombocytopenia was in 63 (73.2%) women and non-pregnancy specific were in 23(26.7%) patients.Conclusions: Preeclampsia and HELLP syndrome is more common cause of thrombocytopenia in pregnancy. Abruption can occur in patients with severe thrombocytopenia. Though platelet count is not routinely done in pregnancy it is advisable to do so as it may help in detecting gestational thrombocytopenia or other immune related condition.

scholarly journals Outcome of Immune Thrombocytopenia in Pregnancy: A French Nationwide Prospective Multicenter Observational Case-Control Study

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 13-14
Author(s):  
Stephanie Guillet ◽  
Valentine Loustau ◽  
Anissa Zarour ◽  
Emmanuelle Boutin ◽  
Thibault Comont ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Immune Thrombocytopenia ◽  
Case Control Study ◽  
Post Partum ◽  
Disease Status ◽  
Case Control ◽  
Severe Thrombocytopenia ◽  
Women Of Childbearing Age ◽  
Childbearing Age ◽  
Control Study

Background: Adult immune thrombocytopenia (ITP) is a rare autoimmune disease that can affect women of childbearing age. The effect of pregnancy on women with a pregestational diagnosis of ITP is still unclear and has never been prospectively studied. Objective: Investigate the effect of pregnancy on the course of ITP. Methods: We conducted a nationwide prospective multicenter observational case-control study (ClinicalTrials.gov NCT02892630). Thirty-three centers from the French ITP reference center network participated in the study. Over a two years period, we enrolled 131 pregnant women with a pregestational diagnosis of ITP and 131 non pregnant women of childbearing age with ITP who served as controls. Matching criteria included: history of splenectomy, disease status (defined as non-responder, responder or complete responder depending on platelet count and the need of treatment modification in the last 2 months) and ITP duration (i.e; persistent (&lt;1 year) or chronic). Cases and controls were followed up for 15 months and platelets counts, hemorrhagic complications and treatment initiation or intensification for ITP were recorded. We defined ITP worsening by a combined score including the occurrence of bleeding and/or occurrence of severe thrombocytopenia (i.e. &lt; 30 G/L) and/or changes in ITP disease status. Results: ITP worsening was significantly increased in pregnant women with ITP when compared to matched controls, affecting respectively 52.7% versus 38.2% (p= 0.05) of patients (figure 1). It occurred mainly during the second and third trimesters. However, the frequency of severe thrombocytopenia (28.2% vs 25.2%, p= 0.69) and incidence of bleeding (22.9% vs 15.3%, p= 0.15) were similar in both groups, even when considering severe bleeding only (Khellaf's bleeding score &gt;7) (16% vs 9.2%, p= 0.11).In contrast, initiation and intensification of therapy were significantly increased in pregnant women compared to matched controls, respectively 32.1% versus 20.6% (p = 0.01) of patients. Importantly, this increased need for therapy did not lead to an increase in maternal and obstetrical complications. In particular, we found no increase of complications that could have been exacerbated by corticosteroid and intravenous immunoglobulins use such as gestational diabetes or high blood pressure. Also compared to pre-gestational period, at 6 months post-partum, only 16.8% of pregnant women showed disease worsening. This frequency was comparable in the control group after 15 months follow-up (16.8%, p = 0.57). Conclusion: The current guidelines on therapy for pregnant women with pregestational ITP are mostly based on expert opinions and retrospective studies that mainly recommend treatment for pregnant women with a platelet count &lt; 30 x 109/L. This prospective observational study investigating ITP progression during pregnancy shows that women with ITP were more intensively treated during pregnancy compared with matched controls. Paradoxically, this does not coincide with an increased of clinical or biological worsening in pregnant womenwhich raises questions of the relevance of this therapeutic conduct although we cannot exclude that these therapies may have prevented disease progression during pregnancy. Finally in late post-partum period, disease worsening was low and seems to be link to the natural course of the disease. Disclosures Haioun: Celgene: Honoraria; Janssen: Honoraria; Gilead: Honoraria; Takeda: Honoraria; Novartis: Honoraria; Roche: Honoraria; Servier: Honoraria; Amgen: Honoraria; Miltenyi: Honoraria. Mahevas:GSK: Research Funding. Michel:Rigel: Consultancy; Alexion Pharmaceuticals: Consultancy; Bioverativ: Consultancy. Godeau:Novartis: Honoraria; LFB: Honoraria; Amgen: Honoraria; Amgen: Research Funding.

scholarly journals Modern approaches for perinatal management in thrombocytopenia during pregnancy

2021 ◽  
pp. 64-69
Author(s):  
О.М. Naumchik ◽  
◽  
Iu.V. Davydova ◽  
A.Yu. Limanska ◽  
◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pregnant Women ◽  
Immune Thrombocytopenia ◽  
First Trimester ◽  
Care Plan ◽  
General Tendency ◽  
Gestational Thrombocytopenia ◽  
Target Values ◽  
Minimum Number ◽  
Perinatal Management

The most common diseases of the blood system in pregnant women are anemia and thrombocytopenia (TP). There is a general tendency to significantly reducing of the number of platelets during pregnancy, starting from the first trimester with a minimum number of them during childbirth. Purpose — to learn the features of motion of pregnancy, diagnostic and curative tactician at the thrombocytopenia during pregnancy. The causes of TP during pregnancy are three groups of conditions — conditions for which TP is characteristic outside of pregnancy and conditions associated with pregnancy: gestational thrombocytopenia (GTP), pregnancy-specific complications, manifestations of diseases characterized by TP, with the chief reason among them — immune thrombocytopenia (ITP). The most common cause of TP during pregnancy is GTP, which, like ITP, is diagnose of exclusion that require differential diagnosis. The goal of treating TP during pregnancy is to achieve a safe platelet count that is different for each trimester, not target values. If the treatment of ITP is need lines of therapy with control of efficiency are consistently applied. Pregnant women with moderate and severe TP are a group of high perinatal risk, requiring careful differential diagnosis of the causes of TP, calculation of maternal and fetal risks, choice of tactics of such pregnancy, method and time of delivery, formation of postnatal care plan. No conflict of interest was declared by the authors. Key words: pregnancy, thrombocytopenia, immune thrombocytopenia, gestational thromocytopenia.

Glycoprotein Ibα clustering induces macrophage-mediated platelet clearance in the liver

2015 ◽  
Vol 113 (01) ◽  
pp. 107-117 ◽  
Author(s):  
Na Ma ◽  
Lili Zhao ◽  
Cao Lijuan ◽  
Yiwen Zhang ◽  
Jie Zhang ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Intravenous Injection ◽  
Guinea Pigs ◽  
Immune Thrombocytopenia ◽  
Underlying Mechanism ◽  
Therapeutic Strategies ◽  
Integrin Αiibβ3 ◽  
N Terminus ◽  
Cynomolgus Macaques ◽  
Independent Mechanism

SummaryMany immune thrombocytopenia (ITP) patients, particularly patients with anti-glycoprotein (GP) Ib-IX autoantibodies, do not respond to the conventional treatments such as splenectomy. However, the underlying mechanism remains unclear. Here we found that anti-GPIbα N-terminus antibody AN51, but not other anti-GPIbα antibodies (AK2, HIP1, VM16d, or WM23), induced GPIbα clustering that led to integrin αIIbβ3-dependent platelet aggregation. After intravenous injection, AN51 dose-dependently induced thrombocytopenia in guinea pigs, and the platelets were mainly removed by macrophages in the liver. N-acetyl-D-glucosamine, previously shown to inhibit integrin αMβ2-mediated phagocytosis of refrigerated platelets, dose-dependently inhibited AN51-induced platelet clearance. Furthermore, AN51 but not VM16d, induced rapid platelet clearance in the liver of cynomolgus macaques. Five of 22 chronic ITP patients had anti-GPIbα autoantibodies, and the autoantibodies from four of the five patients competed with AN51 for binding to platelets. These data indicate that GPIbα clustering induced by anti-GPIbα N-terminus antibody causes integrin αIIbβ3-dependent platelet aggregation, phagocytosis, and rapid platelet clearance in the liver. Our findings reveal a novel Fc-independent mechanism underlying the pathogenesis of ITP, and suggest new therapeutic strategies for ITP patients with anti-GPIbα autoantibodies.

Effect of L-Arginine load on platelet aggregation, a comparison between normotensive and preeclamptic pregnant women

1999 ◽  
Vol 78 (6) ◽  
pp. 515-519 ◽  
Author(s):  
Fabio Facchinetti ◽  
Isabella Neri ◽  
Frederica Piccinini ◽  
Marco Marietta ◽  
Ugo Torelli ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Pregnant Women

scholarly journals Mobile applications in women’s health education in obstetric and gynecological care

2020 ◽  
Vol 19 (2) ◽  
pp. 57-67
Author(s):  
Monika Walec ◽  
Natalia Surma ◽  
Weronika Michoń ◽  
Barbara Ślusarska
Keyword(s):  
Health Education ◽  
Women’S Health ◽  
Women's Health ◽  
Mobile Applications ◽  
New Technologies ◽  
Obstetric Care ◽  
Self Control ◽  
Mobile Health Applications ◽  
Range Of Functions ◽  
Gynecological Care

AbstractIntroduction. The dynamic development of new technologies and the dissemination of mobile applications in everyday life create opportunities for using the new form for activities within the framework of women’s health education.Aim. The work aims to review mobile applications that can be used in women’s health education in obstetrics and gynecology, and to determine their range of functions facilitating independent control of women’s health.Material and method. The research of mobile applications was limited to the ones available for Android and iOS (iPhone). The source of all information are the websites of the software producers. The criteria for including the application in the analysis were: availability on the website play.google.com and usefulness in obstetric-gynecological care of women. As many as 27 applications with the highest number of downloads became the subject matter of the analysis.Results. Due to the substantive scope of women’s health education, mobile applications were classified into three groups: 1) helpful in controlling the menstrual cycle, 2) helpful in monitoring pregnancy, 3) used in the prevention of diseases in gynecological-obstetric care. Out of all the applications available, 10 were classified to the first and second group each, and 7 to the third one.Conclusions. Mobile health applications are a promising strategy for health education as a tool for monitoring, improving self-control, and raising awareness in the care of women.

scholarly journals Barreras en la atención de la morbilidad materna en Yaxkukul, Yucatán, México

2019 ◽  
pp. 28-37
Author(s):  
Elsa RODRÍGUEZ-ANGULO ◽  
Marita SOLÍS-RIVERO ◽  
Ricardo OJEDA-RODRÍGUEZ ◽  
Guadalupe ANDUEZA-PECH
Keyword(s):  
Pregnant Women ◽  
Rural Health ◽  
Obstetric Care ◽  
Cross Sectional ◽  
Obstetric Emergency ◽  
A Value ◽  
Rural Health Center ◽  
Quality Of Obstetric Care ◽  
Three Delays

Objectives. Identify the barriers that cause delays in the route of obstetric care in pregnant women of Yaxkukul, Yucatán, from January 2016 to May 2018. Methodology. Observational, descriptive, cross-sectional and retrospective study. Pregnant women who attended prenatal control at the rural health center of Yaxkukul were interviewed and reviewed their clinical record. Sociodemographic characteristics, prenatal control were studied and the critical route of obstetric care was described, under the model of the three delays. Percentages, measures of central tendency and dispersion were calculated; as well as square chi to look for association between delays and maternal morbidity. A 95% confidence level and a value of p <0.05 were used. Contribution. The present study contributes to the prevention of maternal and perinatal mortality. Knowing the barriers that cause delays in care can identify deficiencies in the obstetric emergency protocol established in rural health units, to improve the quality of obstetric care.

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